Early intervention brings comp success

Nursing staff deliver, costs slashed

Intel in Santa Clara, CA, has an impressive workers’ compensation record. Over the past four years, the injury rate at Intel has been reduced by an average of 33% each year from each previous year. In 1997 alone, Intel’s injury rate dropped 39%, and its lost-day case rate fell 42% compared to 1996. With an impressive 0.74 recorded injuries per 100 employees, the semi-conductor giant credits its success with its emphasis on prevention and its aggressive medical case management.

Intel employs 120 occupational health nurses and 10 nurse case managers worldwide who move in quickly to manage the case when an employee is injured, says Susan Adams, RN, BA, COHN, senior corporate occupational health nurse for Intel based in Chandler, AZ. "Our basic philosophy is to provide 24-hour by seven-day coverage for all our manufacturing facilities. Our nurse case managers support the occupational health nurses on-site under the supervision of the occupational health manager by taking over medical management of cases when they reach the reportable stage." (See box at right for Intel’s formula for determining nurse-to-employee ratios.)

"We don’t want to leave cases to the workers’ comp administrator to handle," adds Joe Crunk, corporate safety and security director for Intel based in Chandler, AZ. "You have to maintain personal contact between the employee and the company to be as successful as we’ve been. There are times when a physician makes a recommendation to the employee, and supervisors at the company are unaware of those recommendations. The case manager maintains close contact with the physician and keeps everyone well-informed about each case."

Adams has no direct authority over the nurse case managers but does oversee their performance. "We have routine teleconferences and met twice a year for face-to-face meetings," she says. "In teleconferences, we work on projects and review case studies. We bring certain challenging cases to our teleconferences so that the assigned case manager can receive input from every one."

We believe that any injury is preventable’

Case management staff also play an important role in several companywide projects. "Right now, case managers are working with our legal team on Americans with Disabilities Act (ADA) compliance issues and medical leave of absence guidelines," Adams says.

Aggressive medical management is not the only key to Intel’s success, Crunk says. "We believe that any injury is preventable. I don’t want people to get the impression that if you hire enough nurses, you can control your medical costs. Prevention is an essential part of our total program." In addition to its nursing staff, Intel employs 20 ergonomists.

Intel begins preventing injuries long before new equipment is even introduced to its employees. "We spend a lot of time working with our suppliers and equipment manufacturers before equipment is brought into our manufacturing plants. We’re a pioneering company. Many times it’s the first time some of this equipment will be used by any organization. We want to look closely at that equipment and make sure it’s built as safely and ergonomically correct as we know how."

In addition, Intel spends a lot of time on employee awareness and training programs on ergonomic issues. "We had a big effort starting in 1992 to train employees how to prevent injuries by getting help before serious problems arise," says Crunk. "Employees are trained to report to the nurse the minute they notice a pain in their elbow or wrist after using certain equipment. The nurse looks at the equipment and observes the employee working and, often with the help of an ergonomist, makes suggestions for changing the setup or the task frequency. If necessary, the nurse refers the patient to physical therapy," he says, adding that Intel provides in-house physical therapists in many of its organizations.

"None of us work in isolation. We work in teams with other disciplines on each case, as well as general safety concerns," Adams says.

The emphasis on ergonomics also has yielded excellent results, she notes. Intel’s musculoskeletal disorder rate was 1.13 injuries per 200,000 man-hours worked in 1994 compared to 0.13 injuries per 200,000 man-hours worked, or a reduction of 88%.

In 1991, Intel benchmarked several companies it felt had excellent safety records and looked closely at how those companies were managing their safety programs. "We created our own safety model, and the prime contributor to our success is the safety self-assessment each major organization in Intel conducts annually."

Intel organizations are asked to score themselves on a number of safety areas, including:

• management commitment;

• line management and accountability;

• safety support personnel, such as nurses and ergonomists;

• safety training;

• motivation and discipline, with an emphasis on individuals disciplining themselves to be more safety conscious;

• results, such as numbers and types of injuries.

Once an Intel organization completes its annual safety assessment, Crunk and an Intel vice president visit each organization to review the survey results. "We spend a full day at each organization. We take a tour of the facility. We talk to personnel and look closely at conditions. We even have lunch with a cross section of employees to get their feedback about current conditions and suggestions for future improvements," he explains.

Crunk presents a quarterly update of environmental health and safety programs to senior management. Also, he sends out a monthly electronic report on the status of each Intel organization’s safety performance.

"We compare this year’s performance to last year’s and rank organizations to show how they’re doing compared to other Intel organizations," he says. "Organizations that have successfully reduced their injuries get recognized. We’ve built a fair amount of pride in that recognition."